U.S. President Barack Obama, speaking to a joint session of Congress on health care at the U.S. Capitol in Washington on Wednesday, said the 'death panels' rumour 'is a lie, plain and simple.' (Jason Reed/Associated Press)

Sarah Palin is off working on her memoirs somewhere, so she wasn't in the audience Wednesday to hear President Barack Obama call her a liar.

Palin is the most prominent politician to have promoted the idea that Obama wants to create some sort of Third Reich-style medical bureaucracy that would decide whether the disabled and the elderly deserve to live, or just have their health care terminated.

"Death panels," Palin called them, in one of the most calculated, incendiary falsehoods of the entire health-care debate. It embarrassed even some of her fellow right wingers.

But it served its purpose, scaring the living daylights out of older voters and churning up so much anxiety over the summer that Obama was forced to address it in his speech to Congress this week.

The death panels rumour, said Obama, "would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."

In the same speech, though, Obama cited a few uniquely American anecdotes not too far from just the sort of thing Palin and her cohort are predicting:

• An Illinois man whose health insurance was cut off in the middle of chemotherapy because an enterprising researcher at the insurance company discovered he hadn't reported gallstones he didn't even know he had. With his treatment cut off, he proceeded to die.
• A Texas woman who was about to undergo a double mastectomy when her health insurer cut her off, citing an unreported case of acne earlier in her life. By the time she got the decision reversed, said Obama, her breast cancer had more than doubled in size.

These are common stories here, reported in the media just about every day.

• The Los Angeles woman with lupus, fluid in the heart and pancreatic cancer who was cut off health coverage because of unreported earlier back pain (which she says isn't even true).

And of course, it doesn't have to be true. Or even remotely related to your illness. It just has to be in your doctor's notes, or hinted at in your doctor's notes, even if your doctor didn't tell you about it.

The moment the insurance company finds it, bang! Your treatment is cut off. And the insurers really start looking for excuses once you get sick and start submitting costly claims (one insurer, Health Net, has actually admitted paying bonuses to employees who dig up reasons to maroon sick clients).

If your treatment is life-preserving, like chemotherapy, and you can't find some other way to pay, you die.

The industry term for cancelling a policy on some sort of technical grounds is "rescission," and it is probably the most odious practice of an industry known for some pretty predatory behaviour.

Sarah Palin is the most prominent politician to have promoted the idea that U.S. President Barack Obama wants to create some sort of Third Reich-style medical bureaucracy. (David Zalubowski/Associated Press)

Now, imagine for a moment what the reaction would be if federal or state governments started directing public servants to comb medical histories for the slightest excuse to cut off life-saving care. (It's not well understood abroad, and sometimes not very well understood here, but the American government is already in the health-insurance business, big time. Medicare pays health-care bills for senior citizens, and Medicaid, the state-run programs, pay to treat the indigent).

The answer is obvious. It would be called what it is: Brutal, near-criminal, disgusting, inhuman behaviour. Maybe even death panels. And it wouldn't last long once the public found out.

The curious thing is, when private companies do it, companies whose profit motive is diametrically opposed to the well-being of their clients, the American public remains relatively supine.

This sort of thing has been going on here for years, and while the horror stories are denounced regularly by liberal activists and routinely retailed by Democrats in stump speeches, it seems to be regarded by the public at large as just business. As in: "Well, they do have shareholders to answer to."

Obama relates 'true story' from citizen

In the minds of many here, business is good for America, and whatever business has to do to make money is good for America, too.

Certainly you don't hear much about health insurance rescission from Sarah Palin, or Senator Jim DeMint, or the Christian conservative leaders who are now mobilizing against Obama's plan. They have various motives. Palin wants to be president. The evangelicals believe Obama's plan will lead to publicly financed abortion. Others, like DeMint, have stated flatly they simply want Obama to fail.

But where great swathes of the public are concerned, the antipathy to publicly funded medicine is something else. Clearly, a lot of people here fear any plan run by their own government more than that of the most venal insurance company.

It's partly the innate distrust of government itself among conservative Americans, and it's partly the widespread American self-image as a nation of rugged individualists who scorn public handouts, as delusional as that may be (see earlier reference to Medicare and Medicaid, not to mention the ocean of public subsidies that flow from Washington).

Obama himself has been talking about a woman who sent him a letter containing a stern admonition: "'I don't want government-run health care. I don't want you meddling in the private marketplace. And keep your hands off my Medicare.'"

"True story," says Obama, when he tells it.

And sort of pathetic, given the stakes of what's going on here.

Shortcomings of government-funding medicine

The fact is, there is so little understanding of what really exists here now and what is actually being proposed that for Palin and her cohort, working against Obama's plan amounts to picking low-hanging fruit.

After Obama's speech, the Washington Post quoted a middle-aged woman sitting in the waiting room of a local hospital.

The speech, she said, sent her blood pressure up: "For every story he tells about somebody that doesn't have insurance, there's one you can tell about somebody who wouldn't get treatment because the government wouldn't allow it."

Well, as somebody who lived for 40 years in a country that has one of the most strictly public health systems in the world, I know all about the shortcomings of government-funded medicine. But in all those years, I never saw anything like what the insurance companies here are capable of.

To borrow one of Palin's attack phrases: "Downright evil."